Provider Demographics
NPI:1578757910
Name:SAGE SOCIAL SERVICES, PC
Entity Type:Organization
Organization Name:SAGE SOCIAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-725-3413
Mailing Address - Street 1:101 PEACEFUL LN
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-1007
Mailing Address - Country:US
Mailing Address - Phone:210-725-3413
Mailing Address - Fax:210-945-8489
Practice Address - Street 1:101 PEACEFUL LN
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-1007
Practice Address - Country:US
Practice Address - Phone:210-725-3413
Practice Address - Fax:210-945-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20064101YP2500X
251B00000X, 261QM0801X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20064OtherTX LIC NUMBER